Orthopaedics Flashcards
What are the X-ray changes in osteoarthritis
LOSS
Loss of joint space
Osteophytes
Subarticular sclerosis (increased bone density along joint line)
Subchondral cysts (fluid holes in bone)
How long is VTE prophylaxis given for in joint replacements
28 days post hip
14 days post knee
What are the features of a colles fracture
Transverse fracture of the distal radius near the wrist
Posterior displacement causes dinner fork deformity
Fall onto an outstretched hand
What are the features of a scaphoid fracture
Fall on an out stretched hand
Tender anatomical snuffbox
Susceptible to avascular necrosis as it only has supply from blood vessels none direction
What bones are susceptible to avascular necrosis
Scaphoid, femoral head, humeral head, talus, navicular, 5th met
What is the Weber Classification of ankle fractures
Type A- below the ankle joint- syndesmosis intact - weight bear in air cast boot or a below the knee cast
Type B- Level of ankle joint - Syndesmosis intact or partially torn- below the knee cast
Type C- Above the ankle joint- syndesmosis disturbed- surgical fixation needed
What are some side effects of bisphophonates and what is an alternative drug to give
Reflux and oesophageal erosions
Atypical features
Osteonecrosis of the jaw
Osteonecrosis of external auditory canal
Can give denosumab
What is Gurds criteria for fat embolism
Gurd’s major criteria
Resp distress
Petechial rash
Cerebral involvement
Gurd’s minor
Jaundice
Thrombocytopenia
Fever
Tachy
What are the features of an intra-capsular hip fracture
Break in the femoral neck within the capsule of the hip joint
Affects the area proximal to the intertrochanteric line
Garden classification used
Grade 1- Incomplete fracture and non displaced
Grade 2- Complete fracture and non displaced
Grade 3- Partial displacement (trabecular are at an angle)
Grade 4- Full displacement (trabecular are parallel)
If non-displaced- intact blood supply to femoral head- less risk of avascular necrosis
Displaced will interrupt blood supply
In younger patients can do fracture reduction but in older offer hemiarthroplasty unless patient has high ADLs and good outcomes then offer a total hip replacement
What is the difference between hemiarthroplasty vs Total hip replacement
Hemiarthroplasty- replacing the head of the femur but leaving acetabulum in place
Total hip replacement- replace both head and socket
What are the features of extra-capsular fracture
Leave the blood supply to the femur in tact - don’t need to replace femur
Intertrochanteric fractures occur between the greater and lesser trochanter - treated with a dynamic hip screw
Subtrochanteric fractures- distal to the lesser trochanter- proximal to the shaft of the femur - intramedullar nail used
What are the features of a hip fracture
Groin/ hip pain radiating to knee
No weight bearing
Short, abducted and externally rotated leg
Disruption of shenton’s line is a key sign of neck of femur fracture
What are the features of compartment syndrome
Pressure in a fascial compartment
Acute or chronic
Acute- bone injuries or crush
5P’s
Pain- disproportionate to injury
Paraesthesia
Pale
Pressure
Paralysis
Needle manometry- measure compartment pressure
Emergency fasciotomy
Chronic compartment
Associated with exertion
Pressure falls during rest
Pain, numb, paraesthesia
Still needle manometry and fasciotomy
What are the features of osteomyelitis
Haematogenous contamination most common
Staph aureus
Risk factors
Open fractures
Ortho operations
Diabetes
PAD
IV drug use
Immunosuppression
Prosthetic joints
Presentation
Fever, pain tenderness, erythema, swelling
X-ray signs
-Periosteal reaction - change to bone surface
-Localised osteopenia (thin bone)
Destruction
Management
Surgical debridement
Antibiotic therapy
6 weeks of fluclox possibly with rifampicin or fusidic acid for the first 2 weeks
Fluclox alternatives- clindamycin or vans/ teicoplanin when treating MRSA
Chronic osteomyelitis needs 3 months of abx
What are the features of sarcoma
Soft tissue lump
Bone swelling
Persistent bone pain
How is sciatica managed
Do not use opioids
Use
Amitriptyline or duloxetine
What are the features and causes of caudal equina
Herniated disc usually
Tumours (mets)
Spondylolisthesis
Abscess
Trauma
Red flags
Saddle anaesthesia, no bladder/ rectum sensation- incontinence , bilat sciatica reduced anal tone
Management
Emergency MRI
Lumbar decompression surgery
How is metastatic spinal cord compression treated
This will present with UMNL signs whereas caudal equina compression will show LMWL signs
Back pain, motor and sensory signs
Oncological emergency rapid imaging
High dose dex
Analgesia
Surgery radio chemo
What are the features of spinal stenosis
Gradual onset
If severe can present as caudal equina
Intermittent neurogenic claudication - similar to PAD so do an ankle brachial pressure index
Lower back pain, butt leg pain, leg weakness
Symptoms absent at rest/ when seated
Management
Exercise/ weight loss
Analgesia
Physio
Decompression
What are the features of Achille’s tendinopathy
two types
Insertion tendinopathy- within 2cm of insertion on calcaneus
Mid portion tendinopathy- 2-6cm above insertion
Risk factors
Sports- bball, tennis, track
Inflam conditions
Diabetes
Raised cholesterol
Fluoroquinolone abx (ciproflox/ levoflox)
Pain/ ache in achilles
Stiff, tender, swelling, nodule on palpation
Calf squeeze rest- achilles tendon rupture
Management
RICE, physio, orthotics, Shock wave therapy, surgery
Do not give Steroid injections - risk of rupture
What are the features of Osgood Schlatter disease
Inflam at the tibial tuberosity where patella inserts
10-15 yrs- more common in males
Multiple avulsion fractures as the patella ligament pulls pieces of bone
Tender lump
Hard lump at tibial tuberosity
Management
RICE
NAAIDs
Physio/ stretching
What are the features of a Baker’s cyst
Pain/discomfort
Fullness
Pressure
Palpable lump
Restricted ROM
Lump bigger when standing full extended - disappears when knee flexed
Can rupture - pain, swelling and erythema
USS - 1st line
MRI can be used before surgery
No treatment usually of
RICE
Physio
USS aspiration
Steroid injections
Surgery
What is morton neuroma
Abnormal nerve between 3rd and 4th Metatarsal
High heels/ narrow shoes make it worse
pain at front of foot
Lump in shoe
Pins and needles of distal toes
Metatarsal squeeze test causes pain
Painful click with Mudler’s sign- rubbing two toes together
RICE
Steroid injections
Weight loss
Insoles
Radiofrequency ablation
Sugery
What are the features of frozen shoulder
Inflam an fibrosis in joint capsule of glenohumeral joint
Painful phase-pain worse at night
Stiff phase- active and passive- external rotation most affected
Thawing phase- gradual improvement and return to normal
Usually lasts 1-3 yrs in total
Clinical diagnosis of exclusion
Management
Analgesia
Physio
Intra-articular steroid injections
Hydrodilation
Surgery
How can you tell a patient has supraspinatus tendinopathy
Positive empty can test- pain while resisting the movement as if they are emptying a can of water
How can you tell a patient has Acromioclavicular joint arthritis
Tender AC joint palpation
Positive scarf test– pain wrapping arm across chest
What do each of the rotator cuff muscles to
SITS
SuprAspinatus- Abducts the arm
Infraspinatus and Teres minor- externally rotate
Subscapularis
- internally rotates
What are the features associated with posterior shoulder dislocation
Only happens in seizure or electric shock
What are the features of an anterior dislocation of the shoulder
Humerus moves forward in relation to glenoid
Arm forced backwards whilst abducted and extended - reaching up and out to catch a high ball
Axillary nerve damage is a key complication- regimental badge anaesthesia
Management
Analgesia
Sedation
Closed reduction
Broad arm sling
Perhaps surgery
Post reduction X-ray
What are the features of lateral epicondylitis
Tennis elbow
Outer elbow pain
Lateral epicondyle extends the wrist
Think of serving a tennis ball- arm supinated and wrist extending
What are the features of medial epicondylitis
Golfers elbow
Inner elbow pain
Weak grip strength
Think of dropping a golf ball to the ground
Pronate the arm and flex the wrist
What are the features of De Quervain’s tenosynovitis
Two tendons mainly affected
Abductor pollicis longus
Extensor pollicis brevis
Repetitive strain, pain on radial side of wrist
Bilateral associated with lifting up new born babies
Pain can radiate to forearm
Pain when patient makes a first and adducts (ulnar deivates) their wrist
RICE
Surgery to cut the retinaculum
What are the features of trigger finger
Thickened tendon in a sheath
Most common in the MCP joint
Nodule on the tendon- locking of the finger in a bent position when trying to extend
Painful pop or click
40s and 50s
Women
Diabetes
Typically worse in morning
RICE
splitning Steroid injections
Steroids to release A1 pulley
What are the features of Dupuytren’s contracture
Autosomal dom patter
Male
Manual labour
Diabetes
Epilepsy
Smoking and alcohol
Ring finger most often affected
Thick cord felt in palm of affected finger
Patient can’t put hands flat on a table
Needle fasciotomy to loose the cord
Can be caused by phenytoin
What are the features of carpal tunnel syndrome
Compression of median nerve
Thumb index finger and lateral half of ring finger affected - sensory affected
Thenar muscles- motor affected
Risk factors
Repetitive strain
Obesity
Perimenopause
RA, Diabetes, acromegaly, hypothyroid
Gradual onset
Numb pain paraesthesia
Symptoms worse at night
Shake hand to relieve
Nerve conduction studies for investigation
Management
Rest
Wrist splints worn at night
Steroid injections
Surgery
What are the features of Salter Harris fractures
Affects growth plates in children
S Type 1- straight across epiphyseal plate
A-Type 2 - Above the plate
L-Type 3- lower than the plate
T- Type 4- Transversing the plate
ER- Type 5 Erasing the plate
